Mr. Suresh, a 63-year-old, went to the clinic complaining of hoarseness of voice and cough. His wife states that his voice has changed in the last few months. The nurse interprets that Mr. Ramesh's symptoms are consistent with which of the following disorders?

1. A

   Laryngeal cancer

2. B

   Chronic sinusitis

3. C

   Coronary Artery Disease

4. D

   Gastroesophageal reflux disease

Appeared in: HPSSC - 2015

Explanation

• Persistent hoarseness lasting more than 2-3 weeks is the most common and often the earliest symptom of laryngeal cancer, especially cancer of the glottis (vocal cords).
• The patient's age (63 years) and the chronic nature of the symptom ('a few months') are significant red flags for malignancy, warranting investigation.
• A tumor on the vocal cords impedes their normal vibration during speech, leading to a harsh, raspy voice and sometimes a persistent cough, which matches the patient's presentation.

Why Other Options Were Wrong

• Option B: Chronic sinusitis primarily presents with symptoms related to the nasal passages and sinuses, such as nasal congestion, facial pain or pressure, and purulent post-nasal drip.
• Option C: Coronary Artery Disease (CAD) is a cardiovascular condition. Its classic symptoms are related to cardiac ischemia, such as chest pain (angina), shortness of breath, and fatigue.
• Option D: While Gastroesophageal Reflux Disease (GERD) can cause hoarseness from acid irritating the larynx (laryngopharyngeal reflux), this hoarseness is typically intermittent, often worse in the morning, and accompanied by other classic GERD symptoms like heartburn and regurgitation.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Differential diagnosis of persistent hoarseness in an adult to guide bedside assessment, documentation, and the next nursing action.
• Nurses must recognize that any patient presenting with hoarseness lasting more than 2-3 weeks requires an urgent referral to an Ear, Nose, and Throat (ENT) specialist for laryngoscopy to rule out cancer.
• A key nursing role involves taking a thorough history, specifically asking about risk factors for laryngeal cancer, such as tobacco and alcohol use, which are the most common causes.
• Patient education on the importance of seeking prompt medical evaluation for persistent voice changes is a critical patient safety intervention.

How to Approach the Question

• First, identify the key information in the clinical scenario: a 63-year-old male, a chronic symptom (hoarseness for 'a few months'), and an associated symptom (cough).
• Recognize that persistent hoarseness is a 'red flag' symptom, especially in an older adult. The duration ('few months') is a critical clue that this is not a simple, acute issue.
• Evaluate each option based on this primary symptom. Ask, 'Which of these conditions most directly and commonly causes persistent hoarseness?'
• Laryngeal cancer directly affects the vocal cords, making it the most direct and serious cause of persistent voice changes.
• Systematically rule out the other options by considering their typical presentations: Sinusitis (nasal symptoms), CAD (cardiac symptoms), and GERD (reflux symptoms, often with intermittent hoarseness).
• Conclude that the presentation is most consistent with laryngeal cancer due to the specific, persistent, and localized nature of the primary symptom in a patient of this age group.

Concept Tested & Keywords

• Concept Tested: Differential diagnosis of persistent hoarseness in an adult.
• Stem keywords: 63-year-old, hoarseness of voice, cough, few months
• Lead-in keywords: consistent with
• Clinical cues: Age: 63-year-old (higher risk for malignancy)
• Clinical cues: Symptom duration: 'few months' (chronic, persistent symptom exceeding the 2-3 week red flag period)

Question ID

QCZAl3WmbItBVr1LbkvYvy

Copy ID

Reference Book

E6 Nursing Brunner Adult Health 3SA Vol 2 Part 1 p. 45-47

E6 Medicine Harrison 22e Part 1 p. 301-303